Updates in Diagnosis and Management of Neonatal Cholestasis

Abstract

Neonatal jaundice refers to the yellow coloration of the skin and sclera of newborn babies that results from hyperbilirubinemia. About 50% of term and 80% of preterm babies develop jaundice in the first week of life. Jaundice is also a common cause of readmission to hospital after early discharge of newborn babies. Jaundice mainly develop due to two factors—the cessation of fetal hemoglobin as it is substituted with adult hemoglobin and the comparatively immature metabolic trails of the liver, which are incapable to conjugate and so expel bilirubin as quickly as an adult. This grounds an accretion of bilirubin in the blood (hyperbilirubinemia), causes the symptoms of jaundice. The typical results in an infant who has cholestasis are prolonged jaundice, scleral icterus, acholic stools, dark yellow urine, and hepatomegaly. Trying of diagnosis of children with jaundice must begin with the classification of serum bilirubin into total bilirubin and direct (or combined) bilirubin. Phototherapy is introduced based on risk influences in the nomogram and  serum bilirubin levels. IV immunoglobulin is suggested for cumulative bilirubin levels from isoimmune hemolysis regardless of phototherapyand exchange transfusion is designated if there is a risk of neurologic dysfunction regardless beginning of phototherapy. This review aims to summarize current evidence regarding epidemiology, etiology, diagnosis and management of neonatal cholestasis.